BOSS Business of Surgery Series

The Real Economics of Rural Surgery with Dr. Randy Lehman In this episode of the BOSS Business of Surgery Series, host Dr. Amy Vertrees sits down with rural surgeon Dr. Randy Lehman for a wide-ranging conversation about rural surgery, financial freedom, and the future of surgical practice. Dr. Lehman shares his unconventional journey, from growing up on a farm in northwest Indiana to becoming a national advocate for rural surgery—complete with a helicopter commute between hospitals. Together, they explore what makes rural surgery uniquely fulfilling, why independent practices struggle in today’s healthcare economy, and how financial independence can transform a surgeon’s career options and impact. What You’ll Learn in This Episode Dr. Lehman’s Path to Rural Surgery Growing up on a farm, switching from pre-pharmacy to pre-med, and discovering a passion for rural surgery at Purdue and UC Medical School. He describes the unexpected doors that opened and closed along the way, eventually leading him to Mayo Clinic’s rural surgery track and a broad, high-volume surgical experience. What Rural Surgeons Really Do Rural surgery offers a broad scope of practice and the ability to care for patients of all ages—often with higher compensation for lower-acuity operations. Dr. Lehman shares examples from his own practice, which spans carpal tunnels to hysterectomies to skin cancer flaps, as well as why he avoids highly complex cases that require tertiary-care resources. Training That Prepares You for Everything He explains the difference between simply rotating through a rural hospital and completing true rural surgery training, which requires high volume across multiple specialties. His own training included over 1,600 cases—far above the national average. The Hard Truth About Practice Models Dr. Lehman opens up about the highs and lows of his post-residency years, including: Pursuing a job at his hometown hospital after it was sold Building a dual-location practice between two small hospitals Attempting an independent practice with $600k annual overhead and only $350k collection Writing $20–30k checks every few weeks just to keep the doors open The takeaway: in today’s economic environment, hospitals subsidize surgeons because they recoup facility fees—while most independent practices cannot survive on professional fees alone. Understanding the Economics: RVUs, Overhead, and Reality He breaks down why his independent practice collected only $57 per RVU versus over $100 per RVU when employed—and what that means for surgeons who dream of autonomy. Dr. Lehman and Dr. Bertrand discuss the impact of decreasing reimbursement, increasing overhead, and the future risk of efficiency adjustments and bundled CPT payments. Financial Freedom as a Career Strategy Dr. Lehman's philosophy is simple and powerful: live on very little early in your career, invest wisely, and achieve financial independence fast. He shares: How buying an $86,000 home allowed him to reach financial freedom within two years Why minimalism amplifies your negotiating power The role of real estate in accelerating independence How financial freedom allows him to give away hundreds of thousands of dollars each year Why money magnifies your character—good or bad Building “The Rural American Surgeon” Podcast Despite costing nearly $50,000 per year to produce, his podcast is a passion project aligned with his goal of becoming a national rural surgery leader. He shares why telling these stories matters for rural hospitals, local economies, and the future surgical workforce. Entrepreneurial Thinking in Medicine Dr. Vertrees and Dr. Lehman close with a powerful discussion on why physicians must think like entrepreneurs—not simply RVU generators. They explore how surgeons can reclaim autonomy, redefine their value, and build careers with freedom, flexibility, and mission at the center. Chapters 00:00:00 – Dr. Randy Lehman’s Background and Journey 00:03:47 – The Scope and Benefits of Rural Surgery 00:06:00 – Rural Surgery Training and Case Volume 00:13:18 – Practice Models After Residency: Wins and Struggles 00:20:04 – The Real Economics of Surgical Practice 00:29:56 – Financial Philosophy & Becoming Independent Early 00:42:07 – Creating The Rural American Surgeon Podcast 00:47:56 – Entrepreneurial Mindset and Physician Autonomy Action Items & Takeaways Seek a true rural surgery training track, not just rural exposure. Prioritize high-volume operative experience during residency. Buy a modest first home to accelerate financial independence. Practice generosity early, regardless of income. Explore rural surgery as a deeply rewarding and high-impact career path. Connect with Dr. Lehman at ruralamericansurgeon.com for more resources.

Summary This episode of the Boss Business of Surgery Series (episode 208) continues the discussion on expanding emotional capacity, specifically focusing on how other people can help surgeons expand their emotional capacity. The host discusses how surgeons traditionally focus on improving skills and knowledge throughout their careers, but emotional capacity is equally important yet often overlooked. The host explains that emotional capacity refers to one's ability to handle the emotional ups and downs of being a surgeon, particularly the negative emotions that arise from complications or difficult cases. When emotional capacity diminishes, surgeons may compensate by overworking, checking charts repeatedly, or spending excessive time with patients, which reduces efficiency and effectiveness. The speaker outlines several ways that other people can help expand a surgeon's emotional capacity: Finding a community of supportive individuals who provide a grounded, safe presence where surgeons can explore their emotions without judgment. These could be mentors, colleagues, spouses, coaches, or therapists. Looking for role models who demonstrate effective emotional management in similar circumstances, and learning from their approaches. Finding safe spaces to be authentic and vulnerable, which allows surgeons to understand themselves better, including how their weaknesses are often the flip side of their strengths. Seeking people who will appropriately challenge and stretch them, recognizing that expanding capacity for positive emotions also expands capacity for negative ones. Learning when to take breaks and how to properly recover from emotional strain, while addressing underlying thoughts and feelings rather than just removing stressors. Connecting with others who help identify meaning in their work and celebrate wins together through practices like "positivity rounds." Developing self-compassion through mindfulness, recognizing common humanity, and speaking kindly to oneself. The host emphasizes that expanding emotional capacity allows surgeons to feel more deeply, recover faster from setbacks, and stay grounded during intense situations. The episode concludes with an invitation to join the Boss Surgery community, which provides a safe space for surgeons to develop these relationships and expand their emotional capacity. Chapters Introduction to Expanding Emotional Capacity ‎ 00:00:00 The host introduces episode 208 of the Boss Business of Surgery Series, continuing the discussion on expanding emotional capacity with a focus on how other people can help. The host invites listeners to find their community and mentions the opportunity to join bosssurgery.com for 2026 while starting immediately. Skills, Knowledge, and Emotional Capacity in Surgery ‎ 00:01:01 The host explains how surgeons traditionally focus on improving skills (techniques practiced repeatedly) and knowledge (gained through experience and reading). While these improve over time, emotional capacity can diminish, especially after complications that bring up negative feelings like worry, insecurity, guilt, and shame. When emotional capacity diminishes, surgeons often compensate by overworking, checking charts excessively, or spending more time with patients, which reduces efficiency and effectiveness. The Value of Expanded Emotional Capacity ‎ 00:03:36 The host discusses why emotional capacity is important for surgeons, allowing them to manage the big feelings that come with both saving lives and sometimes harming patients. Expanded emotional capacity enables surgeons to feel more deeply (both positive and negative emotions), recover faster from setbacks, and stay grounded during intense situations. The host references previous episodes on lion taming, explaining how staying calm and grounded allows surgeons to provide stable, unhurried, non-judgmental energy to others. Finding People Who Help Expand Emotional Capacity ‎ 00:06:34 The host describes how surgeons can find people who make them feel grounded and safe - mentors, colleagues, spouses, coaches, or therapists. These individuals allow surgeons to explore their emotions without judgment and help them work through difficult thoughts. The host also suggests looking for role models who handle stress and uncertainty with grace, and learning from their approaches. Even online communities can sometimes provide support, though they require sufficient emotional capacity to navigate. Learning from Role Models and Past Self ‎ 00:08:18 The host recommends identifying people who model desired behaviors and emotional management, then learning from their approaches. The host notes that surgeons can also look to their past selves as models, reflecting on what motivated them to become surgeons in the first place (referencing episode 2, "Why We Became Surgeons"). This helps surgeons reconnect with their authentic selves in safe environments where they don't feel defensive or competitive. Understanding Strengths and Weaknesses ‎ 00:10:53 The host explains how coaches help surgeons understand their motivations, strengths, and weaknesses. Importantly, weaknesses are often the flip side of strengths - understanding this connection helps surgeons learn about themselves during times of insecurity or threat. Finding people who help surgeons understand themselves more deeply makes them more individually capable. The Challenge of Stretching Emotional Capacity ‎ 00:12:08 The host discusses how high-achieving surgeons want to feel challenged and be at the leading edge of their capabilities. Using a bell curve analogy, the host explains that expanding capacity for positive emotions (thrilled, challenged, stretched) also expands capacity for negative emotions (shame, intimidation, worry). As surgeons push boundaries, they must develop strategies to recover from discomfort and remember why they chose this challenging path. Managing Breaks and Avoiding Burnout ‎ 00:16:23 The host addresses how to manage when feeling overwhelmed or "fried." Rather than simply quitting or taking a break without addressing underlying issues, surgeons should understand the thoughts and feelings behind their diminished emotional capacity. The host recommends finding moments of control and agency, even small ones, rather than withdrawing from stressors entirely. This might involve seeking perspective from others and creating literal space in one's emotional capacity. Balancing Achievement with Relationships ‎ 00:20:00 The host warns against the "addiction" of trying to be everything for everybody, which prevents surgeons from developing relationships that expand emotional capacity. These relationships form a safety net that catches surgeons when they fall. Without developing relationships with others and with oneself, surgeons chase highs without protection from the inevitable lows. Finding Meaning and Sharing Wins ‎ 00:22:06 The host discusses how others help identify meaning in surgeons' work through supportive conversations and sharing wins. The host recommends "positivity rounds" - actively listening to and recording positive things patients and colleagues say. Many surgeons miss these affirmations because they're caught up in their thoughts, missing opportunities to be reminded of their impact. Self-Compassion and Support Networks ‎ 00:24:03 The host references Krista Neff's concept of "Fierce Self-Compassion," which includes mindfulness (being present with suffering), common humanity (recognizing others feel similarly), and self-kindness. The host describes an advanced concept of using past and future versions of oneself as guides. The episode concludes with encouragement to connect with others, try positivity rounds, reach out for help, and consider joining the Boss Surgery community or seeking coaching. Action Items Host recommends finding a community that helps expand emotional capacity. ‎ 00:00:12 Host suggests visiting bosssurgery.com to join their supportive community. ‎ 00:00:27 Host recommends looking back at previous episodes on overworking as compensation, emotional capacity, prolonged stress cycle, and lion taming. ‎ 00:02:59 Host suggests identifying people who model desired emotional management and asking them about their approach. ‎ 00:08:18 Host recommends practicing "positivity rounds" by writing down positive things people say about you. ‎ 00:28:32 Host suggests reaching out for help when struggling by asking if others feel the same way. ‎ 00:28:49 Host encourages finding someone outside your relationships (like a coach or therapist) who can ask difficult questions without fear of risking the relationship. ‎ 00:29:02 Host invites listeners to reach out directly or visit bosssurgery.com for group or one-on-one coaching. ‎ 00:30:30

In this episode, Dr. Amy Vertrees—general surgeon, coach, and founder of the Boss Surgeons coaching community—dives into one of the most overlooked competencies in surgical training: emotional capacity. Surgeons are taught how to operate under pressure, handle emergencies, and constantly pursue excellence. But very few are ever taught how to feel the intense emotions that come with the job, let alone process and recover from them. As a result, emotional capacity—rather than building over time like technical skill—often shrinks, quietly eroding confidence, performance, and well-being. This episode breaks down what emotional capacity truly is, why it matters, and how surgeons can intentionally rebuild and expand it. What You’ll Learn in This Episode • Emotional capacity defined—and why surgeons need it Emotional capacity is the ability to feel, process, and recover from emotions. It is essential for longevity in surgery, yet rarely discussed in training programs that focus almost exclusively on skill and knowledge. • The emotional challenges surgeons face daily Regret, worry, fear, insecurity, and self-doubt aren’t signs of weakness. They’re part of the job. When they go unprocessed, they create burnout, impulsivity, and emotional blunting. • Why emotional capacity can shrink over time Unlike surgical skill, emotional capacity declines if neglected. Unprocessed emotions accumulate and begin to drive behavior, often without awareness. • How to recognize and name emotions with clarity "You cannot process what you cannot name." Dr. Vertrees shares how using the example of regret during a case transfer can transform shame or resentment into motivation and learning. • Managing intensity without being overtaken by it Surgeons constantly shift between high-intensity events and routine interactions. This requires compartmentalization—but too much compartmentalization leads to emotional numbness. • Breaking the prolonged stress cycle Chronic stress signals the body that it is unsafe. Dr. Vertrees explains how simple techniques like box breathing help return the nervous system to safety and restore capacity. • Releasing unrealistic responsibility Surgeons are trained to "own everything," which often leads to carrying burdens far beyond what is reasonable or controllable. • Reconnecting with yourself Disconnection from one’s own needs is one of the earliest and most dangerous signs of burnout. Reconnection is essential for restoring emotional bandwidth. • How to rebuild emotional capacity You’ll hear practical strategies including: Identifying and allowing emotions without judgment Creating micro-pauses Noticing the thoughts generating feelings Allowing joy, gratitude, and celebration to expand capacity Understanding that confidence comes from acting with difficult emotions, not from eliminating them • Coaching as a tool for building emotional strength Dr. Vertrees shares how coaching can help surgeons process emotions effectively, reconnect with themselves, and reclaim confidence. Episode Chapters 00:00:02 — Introduction to Emotional Capacity in Surgery 00:01:29 — Understanding Regret as an Example 00:03:34 — Emotional Capacity vs. Skills and Knowledge 00:05:57 — Expanding Emotional Bandwidth Under Pressure 00:08:05 — Managing Intensity Without Being Overtaken 00:09:44 — Recovery and Compartmentalization 00:11:36 — Self-Regulation and the Prolonged Stress Cycle 00:14:04 — Managing the Load of Responsibility 00:16:05 — Staying Connected with Yourself 00:18:47 — Rebuilding Emotional Capacity 00:26:07 — Conclusion and Coaching Opportunities Action Items for Surgeons If you’re feeling overwhelmed or burned out, reach out to a coach who understands surgeon-specific challenges. Start a small gratitude practice to create space for positive emotions and prevent emotional saturation. Join the Boss Surgeons coaching group—signing up now grants the rest of 2025 free as we enroll for the 2026 program year. Visit bosssurgery.com to learn more about 1:1 coaching, the Boss Surgeons group, and upcoming programs.

🔍 Episode Summary In this episode, Dr. Amy Vertrees explores one of the most pervasive and dangerous habits in surgery: overworking. Surgeons are trained for excellence and rewarded for endurance, but this mindset can quietly erode health, relationships, and even clinical effectiveness. Dr. Vertrees shares her personal journey of learning to set boundaries after years of believing that saying “yes” was part of being a good surgeon. Through honest reflection and practical insight, she uncovers the identity and mindset issues that drive surgeons to work beyond sustainable limits—and why true leadership requires learning to stop. 💡 Key Takeaways Overworking is not productivity—it’s depletion. Surgeons often continue working past the point where their efforts serve any meaningful goal. The work will never be done. There will always be another patient, another chart, another case. Knowing when to stop is an act of leadership, not laziness. Why saying no is so hard. From fear of judgment to feelings of obligation and scarcity, surgeons often override their own limits for reasons that have nothing to do with patient care. Boundaries protect purpose. Overworking gives an illusion of control but actually surrenders it. Boundaries help surgeons stay creative, clear, and compassionate. Five steps to building boundaries: Define limits, plan ahead, list what matters, assess your schedule, and make changes intentionally. 🧠 Quote Highlights “Overworking is when your effort stops serving your goals and starts draining your energy, your relationships, and your purpose.” “The work will never be done—but your capacity will. Protect it.” “We don’t fix burnout by working faster; we fix it by redefining who we are when we’re not operating.” 🗓️ Action Items for Surgeons Define your boundaries—time, effort, and emotional energy. Plan your week in advance and block what truly matters. Review your schedule: does it reflect the life you actually want? Adjust intentionally to align your professional and personal priorities. Remember: you are the authority over your calendar. 🚀 Learn More Enrollment is open for The Boss Surgeons Program 2026, a year-long coaching experience designed to help surgeons lead with clarity, confidence, and purpose. Sign up now and get the rest of 2025 free, including live coaching, access to recordings, and a private podcast library. 👉 Visit bosssurgery.com  to learn more or schedule a conversation with Dr. Vertrees before enrolling.

Moral Courage in Medicine — Leading with Integrity at Every Level Guest: Dr. Jessica Bunin Host: Dr. Amy Vertrees, The BOSS Business of Surgery Series Podcast 💡 Episode Summary In this episode, host Dr. Amy Vertrees sits down with Dr. Jessica Bunin, a West Point graduate, psychiatrist turned critical care physician, and co-founder of All Levels Leadership. With over two decades of military service, Dr. Bunin brings a deep understanding of leadership, followership, and moral courage to the conversation. Together, they explore what it means to practice moral courage in healthcare — especially when values and organizational directives collide. Dr. Bunin shares how her experiences in the military and medicine shaped her commitment to developing leadership skills at all career stages and helping physicians navigate ethical and professional challenges with clarity and resilience. Listeners will walk away with practical frameworks for building moral courage, developing supportive professional networks, and finding fulfillment in environments that may not always align with personal values. 🧭 Key Topics Covered The founding story of All Levels Leadership and its mission to teach leadership at every career stage Redefining followership as "practicing influence when you don’t have authority" The three elements of moral courage — values, risk, and endurance Strategies for navigating moral dilemmas and maintaining integrity in complex healthcare environments How to build a moral courage support system of advisors, peers, knowledge sources, and wellness practices The power of longitudinal coaching and finding mentors who understand your patterns Finding flow and fulfillment even in misaligned organizations Why authentic connection and honesty about career aspirations are key to professional growth 🕰️ Episode Chapters 00:00:02 – Introduction to Dr. Jessica Bunin Background in military medicine and transition to leadership coaching. 00:01:07 – Founding All Levels Leadership Identifying the leadership education gap for early-career physicians. 00:04:03 – The All Levels Leadership Team How a diverse team of clinicians built a mission-driven organization. 00:05:57 – Origins of Moral Courage From teaching followership to exploring moral action. 00:08:56 – Redefining Leadership and Followership How influence, not authority, drives meaningful change. 00:12:37 – Defining Moral Courage Understanding values, risk, and endurance in ethical decision-making. 00:19:21 – Navigating Moral Dilemmas Balancing leadership responsibility with personal integrity. 00:23:22 – The Value of Longitudinal Coaching How sustained mentorship provides clarity and resilience. 00:25:14 – All Levels Leadership Services Coaching, consulting, and education for healthcare professionals. 00:29:57 – Navigating Misaligned Environments Finding joy, building networks, and identifying sources of “flow.” 00:33:18 – The Power of Authentic Connections Why honesty about your aspirations creates better opportunities. ✅ Action Items & Takeaways Build a moral courage support system — advisors, peers, knowledge sources, and wellness practices. Develop long-term coaching relationships for honest feedback and growth. Seek mentors through trusted recommendations, not blind outreach. Identify aspects of work that bring joy and flow to sustain well-being. Maintain professional connections over time, even with minimal contact, to preserve opportunities and trust. 🔗 Resources Mentioned All Levels Leadership  – Coaching, consulting, and leadership education for healthcare professionals. Learn more about Dr. Jessica Bunin and her work on moral courage and professional identity formation. 💬 Favorite Quotes “Moral courage is knowing your values, recognizing the risks of standing up for them, and finding ways to endure the consequences.” – Dr. Jessica Bunin “What we really owe to people is to be our best selves.” – Dr. Jessica Bunin

Summary This podcast episode from the Boss Surgery Series features Dr. Amy Vertries interviewing Dr. Sarah Rasmussen, a pediatric transplant surgeon, about her experience of being in the wrong job and navigating a career transition. Dr. Rasmussen shares her journey from working at the University of Virginia (UVA) to Seattle Children's Hospital and then to a new position that better aligned with her career goals and values. Dr. Rasmussen begins by describing her background as a Gen-Xer born in West Virginia who initially planned to practice medicine with her father. She pursued an MD-PhD program at WVU in 1997, focusing on HIV research at the National Cancer Institute. During her medical training, she discovered her passion for surgery during rotations and completed her residency at Virginia Commonwealth University followed by a pediatric surgery fellowship at Johns Hopkins. She then worked at UVA from 2011 to 2020, where she established a pediatric liver transplant program in partnership with Children's Hospital of Pittsburgh. Dr. Rasmussen explains that leadership changes at UVA led to her role being reduced from performing 42 liver transplants annually to being limited to only pediatric cases (about 5 per year). This significant reduction in surgical volume prompted her to accept a position at Seattle Children's Hospital as the surgical director of pediatric liver transplant, which she accepted just before the COVID-19 pandemic began in early 2020. At Seattle Children's, Dr. Rasmussen encountered challenges that made her realize she was in the wrong job. Despite the hospital performing more transplants (13-15 liver transplants and 30 kidney transplants annually), she faced issues with case allocation, micromanagement of her decisions, and resistance to her suggestions for improving processes. After 18 months, she compiled data showing her limited involvement in transplant cases and presented it to leadership, hoping for change. Instead, this led to increased scrutiny of her abilities. Dr. Rasmussen describes how the job stress affected her health, causing panic attacks, chest pain, and dangerously high blood pressure. With support from her family and through Dr. Vertries' coaching program, she decided to explore other opportunities. She interviewed at four institutions and found a position with a partner who shared her vision and valued her contributions. In her new role, Dr. Rasmussen found a supportive environment where her partner encourages her growth, helps her through complications, and values her strengths. She shares how her new partner supported her through a surgical complication by not letting her isolate herself and helping her move past self-doubt. He also encourages her to take on challenging cases, such as performing laparoscopic procedures on very small infants. The conversation concludes with reflections on the importance of finding the right job fit, the impact of career decisions on family, and how having the right partner can make a significant difference in professional growth and satisfaction. Chapters Dr. Rasmussen's Background and Early Career Path ‎ 00:02:12 Dr. Sarah Rasmussen introduces herself as a Gen-Xer born in West Virginia. She initially planned to practice medicine with her father but became interested in research during medical school. She joined an MD-PhD program at WVU in 1997, focusing on HIV research at the National Cancer Institute. During her clinical rotations, she discovered her passion for surgery, which engaged "all parts of her brain." She completed her residency at Virginia Commonwealth University and a pediatric surgery fellowship at Johns Hopkins. From 2011 to 2020, she worked at the University of Virginia (UVA) as an assistant professor, where she also completed an additional fellowship in abdominal transplant surgery. At UVA, she was active in research, clinical work, teaching, and helped establish a pediatric liver transplant program in partnership with Children's Hospital of Pittsburgh. Transition to Seattle Children's Hospital During the Pandemic ‎ 00:05:21 Dr. Rasmussen explains that leadership changes at UVA led to her role being reduced from performing 42 liver transplants annually to being limited to only pediatric cases (about 5 per year). This significant reduction prompted her to accept a position as surgical director of pediatric liver transplant at Seattle Children's Hospital. She signed her offer letter just before the COVID-19 pandemic began, making the transition particularly challenging as it occurred during social distancing measures. Dr. Rasmussen was attracted to Seattle Children's because they performed more transplants (13-15 liver transplants and 30 kidney transplants annually), and she believed she would have a good working relationship with the program head who had similar training. Challenges at Seattle Children's Hospital ‎ 00:09:27 Dr. Rasmussen describes her initial positive reception at Seattle Children's but quickly noticed concerning dynamics between surgeons during her observation of a liver-kidney transplant on her second day. Despite her efforts to integrate into the team, she faced significant challenges: her clinical decisions were micromanaged, her requests for time off were complicated by "unwritten rules," and she was often excluded from transplant cases because "fellows needed the experience." After 12 months, she realized that her situation wasn't improving despite her efforts to be helpful and engaged. After 18 months, she compiled data showing her limited involvement in transplant cases (only 20% of livers and 15% of kidneys despite being on call 33% of the time) and presented it to leadership, hoping for change. Instead of addressing her concerns, this led to increased scrutiny of her abilities. Recognizing the Need for Change ‎ 00:16:45 Dr. Rasmussen sought advice from colleagues but was consistently told that the situation "would never change." She realized that her vision of being a pediatric liver transplant surgeon required meaningful involvement in cases, which wasn't happening at Seattle. In January 2021, she learned of four potential job openings in her field. Initially resistant to moving her family again so soon after relocating during the pandemic, she joined Dr. Vertries' "difficult partner course" hoping to learn how to succeed in her current position. Through the course, she gave herself permission to explore other opportunities and interviewed at all four institutions. Two positions seemed promising, with one standing out immediately because of her connection with the potential new boss. Health Impact and Decision to Leave ‎ 00:25:56 Dr. Rasmussen describes how the job stress severely affected her health, causing panic attacks manifesting as chest pain and dangerously high blood pressure (190/110 with a heart rate of 197). One night after seeing the clinic and call schedule, she couldn't calm down despite trying mindfulness techniques. Her husband witnessed this and declared, "We are done here." Additional factors influencing her decision included the death of a mentor and her mother's illness. Dr. Rasmussen realized that despite her efforts, the team at Seattle Children's was unwilling to accommodate her career needs, which she viewed as a "breach of contract" - not from the institution but from the team that should invest in its members. Family Considerations in Career Decisions ‎ 00:28:55 Dr. Rasmussen discusses the challenge of considering another move so soon after relocating her family during the pandemic. She worried about uprooting her children who had just established connections in Seattle. A turning point came when her oldest child told her, "Mom, I think it's time for you to worry about yourself. I'm going to be okay." For her job interviews, she took the unusual step of requesting that both potential employers bring her entire family for second visits, not just her spouse. She received advice that "how happy do you think your family can be if mom is not happy?" and realized that many children move multiple times during childhood without negative consequences. She also learned that her oldest child had been bullied at their previous school, reinforcing that staying in Virginia might not have been better for her family. Finding the Right Partner and Environment ‎ 00:47:08 Dr. Rasmussen describes how she connected with her new boss by cold-calling him about a position at his former institution and inquiring if he needed a partner in his new program. Their initial conversation revealed shared vision and energy for building a program. Unlike her experience in Seattle, her new boss explicitly stated, "You tell me what you need out of a case, and that's what will happen," emphasizing team function over hierarchy. She contrasts this with her previous experience, noting the difference between a hierarchical environment and one with a shared vision. When she experienced a serious complication in her first liver transplant at the new institution, her partner provided support without judgment, wouldn't let her isolate herself, and eventually told her "it's time to stop" ruminating, while acknowledging that such complications happen to everyone. Growth and Support in the New Position ‎ 00:54:01 Dr. Rasmussen shares how her new environment supports her growth through challenging cases. During her first on-call experience, she consulted on a 1.6-kilogram baby with duodenal atresia. Though initially planning an open procedure, she researched laparoscopic approaches and found evidence supporting minimally invasive surgery for this condition. When she proposed this to her boss, he gave no pushback and even came to observe the successful procedure. Three months later, when she hesitated about performing a laparoscopic cholecystectomy on an eight-week-old baby, her boss reminded her, "Three months ago, you did a lap duodenal atresia repair on a 1.6 kilo baby - get over it," encouraging her to trust her a

Summary This episode of the Boss podcast features Dr. Jennifer Whittington sharing her experience with toxic work environments and how she navigated leaving such situations. The host, Dr. Amy Vertries, introduces the podcast as focusing on lessons not taught in residency for surgeons. Dr. Whittington discusses her first job search after residency, where she was geographically limited due to custody arrangements for her daughter. She admits she made a critical mistake by not hiring a contract lawyer to review her employment agreement, which later proved to be problematic. She emphasizes the importance of having legal counsel review contracts, even if it costs around $500, as it's worth the investment to identify potential issues. Dr. Whittington highlights several red flags she missed during her job search, particularly being prevented from speaking with the previous person who held the position. She advises that if an employer discourages contact with previous employees, it's a significant warning sign. She also stresses the importance of getting specific details in writing, such as call distribution, reimbursement, block time, and research time. The conversation then shifts to Dr. Whittington's experience leaving her toxic job. She explains how she carefully planned her exit, ensuring she had credentials at another hospital before resigning, as she anticipated retaliation. She maintained professionalism throughout the difficult two-month notice period, despite facing verbal abuse and humiliation. She shares how staff members showed their support by organizing a farewell party for her despite management's disapproval. Dr. Whittington then discusses her second job, which was a positive experience. She only left this position to care for her sister who was diagnosed with breast cancer. She explains how she took trauma call to pay off her substantial legal fees ($320,000) from her divorce and custody battle, which ultimately made her a better surgeon while helping her become debt-free. Throughout her journey, Dr. Whittington emphasizes the importance of building a support network or "village." When her initial support system fell apart during her divorce, she rebuilt it with colleagues, friends, and community members. She shares emotional stories of friends who supported her during financial hardship, including a friend who traveled to visit her and treated her to simple pleasures like pedicures and ice cream when she couldn't afford groceries. Dr. Whittington concludes by discussing her current position at a hospital where she provides care to underserved populations. She expresses her passion for ensuring that patients at safety-net hospitals receive the same standard of care as those at private hospitals. She also mentions her commitment to mentoring medical students, residents, and PhD students, showing them that they can have successful careers despite personal challenges. The episode ends with Dr. Whittington advocating for subsidized childcare for surgical trainees at a national level, noting that the stress of arranging and paying for childcare can prevent surgeons from focusing on becoming the best they can be professionally. Chapters Introduction to the Boss Podcast and Topic of Toxic Jobs ‎ 00:00:00 Dr. Amy Vertries introduces the podcast, explaining that it focuses on lessons not taught in residency for surgeons. She mentions that two of their most downloaded episodes deal with leaving toxic jobs, and introduces Dr. Jennifer Whittington who will share her experience with toxic work environments and how she navigated leaving such situations. Dr. Whittington's First Job Search and Contract Mistakes ‎ 00:01:13 Dr. Whittington discusses her first job search after residency, explaining she was geographically limited due to custody arrangements for her daughter. She admits she made a critical mistake by not hiring a contract lawyer to review her employment agreement, which later proved to be problematic. A lawyer who reviewed it years later told her "no one reasonable would have allowed you to sign this." She emphasizes the importance of having legal counsel review contracts, even if it costs around $500, as it's worth the investment to identify potential issues. Red Flags in Job Interviews and Importance of Due Diligence ‎ 00:02:36 Dr. Whittington highlights several red flags she missed during her job search, particularly being prevented from speaking with the previous person who held the position. She advises that if an employer discourages contact with previous employees, it's a significant warning sign. She also stresses the importance of getting specific details in writing, such as call distribution, reimbursement, block time, and research time to avoid being "used and abused." Identifying Toxic Workplace Environments ‎ 00:09:22 Dr. Whittington describes signs of a toxic workplace, including lack of respect, being condescended to in front of team members, and feeling uncomfortable with the standard of care provided. She shares her father's advice about being able to "look at yourself in the mirror at night" and feel good about what you did that day, noting that in her toxic job, she couldn't say that about the care being provided. Transitioning Out of a Toxic Job ‎ 00:12:33 Dr. Whittington explains how she carefully planned her exit from her toxic job, ensuring she had credentials at another hospital before resigning, as she anticipated retaliation. She discusses the documentation needed when changing jobs, including licensure verification, risk management documentation, case logs, and letters of recommendation. She emphasizes the importance of having allies who can help navigate this process. Maintaining Professionalism During Resignation ‎ 00:15:21 Dr. Whittington shares how she maintained professionalism during her difficult two-month notice period, despite facing verbal abuse and humiliation. Her mantra was "I am the consummate professional," which helped her not react negatively to poor treatment. She shares how staff members showed their support by organizing a farewell party for her despite management's disapproval. Second Job Experience and Family Emergency ‎ 00:18:03 Dr. Whittington discusses her second job, which was a positive experience. She only left this position to care for her sister who was diagnosed with breast cancer. She explains how the administration was supportive and even held her position as long as possible. She helped interview her replacement and assured them it was a good practice to join. Financial Challenges and Overcoming Debt ‎ 00:24:56 Dr. Whittington reveals how she took trauma call to pay off her substantial legal fees ($320,000) from her divorce and custody battle. This experience not only helped her become debt-free but also made her a better surgeon by improving her efficiency and thoughtfulness. She explains her fear of debt stemming from her lower-middle-class upbringing as a coal miner's daughter. Building a Support Network or "Village" ‎ 00:33:10 Dr. Whittington emphasizes the importance of building a support network or "village." When her initial support system fell apart during her divorce, she rebuilt it with colleagues, friends, and community members. She shares emotional stories of friends who supported her during financial hardship, including a friend who traveled to visit her and treated her to simple pleasures like pedicures and ice cream when she couldn't afford groceries. Current Position and Future Goals ‎ 00:35:26 Dr. Whittington discusses her current position at a hospital where she provides care to underserved populations. She expresses her passion for ensuring that patients at safety-net hospitals receive the same standard of care as those at private hospitals. She also mentions her commitment to mentoring medical students, residents, and PhD students, showing them that they can have successful careers despite personal challenges. Advocacy for Childcare Support in Medical Training ‎ 00:44:10 Dr. Whittington concludes by advocating for subsidized childcare for surgical trainees at a national level. She notes that the stress of arranging and paying for childcare can prevent surgeons from focusing on becoming the best they can be professionally, and expresses her passion for finding ways to address this issue through medical organizations. Action Items Dr. Whittington advised hiring a contract lawyer to review job offers, even if it costs around $500, as it's worth the investment to identify potential issues. ‎ 00:02:52 Dr. Whittington recommended always speaking to the person who previously held the position before accepting a job offer. ‎ 00:04:07 Dr. Whittington suggested going through offer letters point by point with the hiring person, discussing call distribution, reimbursement, block time, and expectations. ‎ 00:03:28 Dr. Whittington advised securing credentials at another hospital before resigning from a toxic job if retaliation is anticipated. ‎ 00:07:14 Dr. Whittington recommended preparing a resignation letter in advance when leaving a difficult workplace situation. ‎ 00:15:36 Dr. Whittington suggested maintaining professionalism when facing verbal abuse or humiliation in the workplace by using a personal mantra like "I am the consummate professional." ‎ 00:16:15 Dr. Whittington advised personally calling patients when transitioning from one practice to another to maintain the relationship and reduce guilt. ‎ 00:21:02 Dr. Whittington advocated for exploring ways to provide subsidized childcare for surgical trainees at a national level through medical organizations. ‎ 00:44:10

Summary This meeting record transcript is a conversation between a host and Dr. Michael Sutherland, the membership director of the American College of Surgeons (ACS). The discussion covers various aspects of the ACS, including its mission, membership benefits, educational resources, advocacy efforts, international outreach programs, and the annual Clinical Congress event. Dr. Sutherland shares his personal journey of getting involved with the ACS as a resident and highlights the opportunities for surgeons at different career stages to participate and contribute to the organization. He emphasizes the value proposition of ACS membership, which includes access to discounted insurance programs, practice management resources, coding and reimbursement support, and personal financial management services. The ACS is described as the largest surgical organization in the world, representing over 92,000 members across 13 surgical specialties. Its mission is to safeguard the standards of surgical practice and elevate the quality of care through various programs, registries, and data-driven initiatives. The organization also plays a crucial role in advocacy and health policy, engaging with government agencies and insurance companies to shape policies that impact surgical practice. Internationally, the ACS has chapters in over 120 countries and runs programs like ACS HOPE (Health Outreach in Underserved Areas) to enhance surgical education and workforce development in underserved regions. The annual Clinical Congress event is highlighted as a premier educational and networking opportunity, offering cutting-edge education, vendor exhibits, surgical simulations, and social networking events. Overall, the conversation aims to raise awareness about the extensive resources and benefits available to ACS members, encouraging surgeons, particularly younger ones, to get involved and take advantage of the organization's offerings. Chapters Dr. Sutherland's Journey with the ACS  00:01:10 Dr. Sutherland shares his personal journey of getting involved with the ACS as a resident when the 80-hour work week was implemented. He started participating in discussions and committees, eventually becoming the chair of the Resident Associate Society and the Young Fellows Association. He emphasizes that the ACS offers opportunities for passionate individuals to engage and contribute to improving patient care and surgical quality. The Value Proposition of ACS Membership  00:18:22 Dr. Sutherland highlights various benefits and resources available to ACS members, including discounted insurance programs (life, disability, accidental death), practice management materials, contract negotiation services, personal financial management resources, coding and reimbursement support, and access to data-driven initiatives like surgical risk calculators. The goal is to provide value-added benefits that make ACS membership a worthwhile investment for surgeons. The ACS as the House of Surgery  00:08:33 The ACS is described as the largest surgical organization in the world, representing over 92,000 members across 13 surgical specialties. Its mission is to safeguard the standards of surgical practice and elevate the quality of care through various programs, registries, and data-driven initiatives. The organization has a strong voice in advocacy and health policy discussions, shaping policies that impact surgical practice. International Outreach and Education  00:11:29 The ACS has chapters in over 120 countries and runs programs like ACS HOPE (Health Outreach in Underserved Areas) to enhance surgical education and workforce development in underserved regions. The program has training hubs in countries like Ethiopia, Rwanda, and Zambia, where attending physicians and residents from the U.S. help educate local surgeons and build self-sustaining surgical capabilities. The Annual Clinical Congress  00:29:07 The Clinical Congress is highlighted as the premier event for the ACS, offering cutting-edge education from subject matter experts, vendor exhibits, surgical simulations, and social networking opportunities. Dr. Sutherland emphasizes the importance of networking and building lasting connections with peers at the event. The Congress also features named lectures, convocation ceremonies, and cultural experiences like the "Taste of the City" event. Engaging Younger Surgeons  00:41:12 Dr. Sutherland acknowledges the challenge of communicating the value proposition of ACS membership to younger surgeons, particularly residents and fellows. The organization aims to eliminate cost barriers by offering free membership during residency and highlighting the various resources and opportunities available to engage and contribute to the ACS at different career stages. Action Items Explore the ACS website (facs.org) and update your member dashboard to ensure your profile information is accurate and tailored to your surgical specialty and interests. 00:37:04 Bookmark and utilize the Surgical Risk Health Calculator available on the ACS website to facilitate informed discussions with patients about potential surgical outcomes based on real data. 00:39:09 Attend the annual Clinical Congress event to access cutting-edge education, vendor exhibits, surgical simulations, and networking opportunities with peers from around the world. 00:31:26 Investigate the various ACS podcasts, including 'House of Surgery,' 'Surgical Readings from SRGS,' and 'The Operative Word,' to stay updated on surgical topics and research. 00:46:01 Reach out to the ACS Member Services team (ms@facs.org) for assistance in finding resources or exploring opportunities to get involved with the organization. 00:43:42 Encourage medical students, residents, and younger surgeons to join the ACS and take advantage of the free membership during residency to experience the value proposition and resources available. 00:41:46

In this episode, Amanda Hill, JD joins Amy to talk about why they relaunched the 90 Day Notice program—and why it’s more important than ever. Drawing from real stories of doctors facing workplace struggles, they highlight the common scenarios physicians are navigating: complications clustered together, staff complaints escalating into formal reviews, sudden RVU changes, and the fear of being “pushed out” without warning. Amy shares her perspective as a surgeon and coach, while Amanda brings decades of experience as a healthcare attorney. Together, they break down why so many doctors feel powerless, what warning signs to watch for, and how to respond with strategy instead of panic. They stress that leaving a job isn’t always the answer—sometimes the solution is learning how to influence opinions, repair professional relationships, and walk through challenges with strength and dignity. Listeners will also hear how the 90 Day Notice program creates real change by blending legal insight, coaching tools, and community support. From navigating workplace conflicts, to avoiding costly missteps, to rebuilding confidence, Amy and Amanda share the process they’ve refined to help physicians reclaim their leverage and peace of mind. If you’ve ever wondered, “Am I the problem? Do I need to quit? Or is there another way?”—this episode shows you that there is a path forward.

In this episode of the Boss Business of Surgery Series, Dr. Amy Vertrees sits down with Dr. Courtney McKeown, who shares her remarkable journey from navigating an operative gap to becoming chief of surgery at a rural hospital. Dr. McKeown opens up about the challenges she faced after being laid off from her first job, her prior recovery from substance use disorder, and the difficulties of securing a new position with a gap in her surgical practice. Together, Dr. Vertrees and Dr. McKeown dive deep into what it takes to return to surgery after time away, from licensing hurdles to credentialing committees, malpractice insurance, and professional references. The conversation also highlights the American Board of Surgery’s reentry guidelines, state-specific policies on operative gaps, and the importance of supportive partners and mentorship during the reentry process. Now serving as chief of surgery, Dr. McKeown reflects on how her experience not only rebuilt her career but also brought life-changing surgical services to underserved communities. Her story is both a candid look at the obstacles surgeons face and an inspiring example of resilience, mentorship, and community impact. What You’ll Learn in This Episode: The challenges of returning to surgery after an operative gap How state licensing boards and disciplinary history affect reentry The step-by-step process of hospital credentialing Why references and case logs are crucial for reentry Insights into the American Board of Surgery’s reentry guidelines The role of mentorship and supportive partners in regaining confidence How Dr. McKeown expanded surgical services in rural Tennessee hospitals Resources & Action Items: 90-Day Notice Program for doctors seeking new positions – launching Sept 28 at 4 p.m. CT Click HERE Keep case logs organized (last 12 months, last 2 years, etc.) for credentialing American Board of Surgery Reentry Guidelines HERE Joint Commission FPPE Guidelines HERE Chapters: 00:00 – Introduction to Dr. McKeown’s journey 01:14 – Background and initial challenges 04:01 – Finding a new position 05:44 – Licensing challenges 07:09 – State requirements for operative gaps 09:13 – Impact on board certification 10:36 – Reciprocal disciplinary actions 16:13 – Malpractice insurance considerations 17:22 – Reference challenges 19:43 – Finding the right practice environment 22:00 – Qualities to look for in partners 24:47 – Mutual benefits of mentorship 36:49 – Hospital credentialing process 42:08 – ABS reentry guidelines 46:58 – Gradual return to independent practice 56:42 – Current success as chief of surgery 59:57 – Expanding services and rural community impact 1:02:25 – Conclusion and future impact 🎧 Listen now to hear Dr. McKeown’s inspiring story of resilience, reentry, and redefining what it means to build a surgical career.

Summary The meeting was day three of a launch week focused on complications in surgery, presented by a surgeon who is also an author, podcast host, and certified coach. The presenter emphasized that complications are inevitable in surgical practice and provided guidance on how to manage them effectively. The presenter began by outlining the main topics to be covered: understanding what a complication is, perfectionist thinking, asking for help, the prolonged stress cycle, self-compassion, managing negative emotions, shame resilience, confidence and self-confidence, and peer review assessment. The presenter defined a complication as a failure to achieve a stated outcome, specifically a perfect procedure where nothing goes wrong. They addressed perfectionist thinking as a double-edged sword - while striving for perfection is admirable, it can lead to fear, overwork, and burnout. The presenter recommended shifting perspective from focusing on the gap between achievement and perfection to celebrating the best effort given with available knowledge and resources. The prolonged stress cycle was discussed as a significant issue for surgeons, where continuous stress without recovery leads to cognitive impairment, decreased empathy, irritability, anxiety, depression, and potentially self-harm. The presenter offered strategies to interrupt this cycle, including deep breathing, music, exercise, mindset work, and community support. For managing complications during surgery, the presenter advised checking one's pulse, taking deep breaths, stepping back to think, asking for help, and considering the next best step. They emphasized the importance of clear communication with partners about expectations when asking for help. After a complication, the presenter stressed the importance of naming emotions, practicing self-compassion, and using shame resilience strategies: reaching out to trusted sources, talking kindly to oneself, and owning the story to control the narrative. They highlighted that patients primarily want to know what happened, that the surgeon did their best, that they won't be abandoned, and that learning occurred from the experience. The presenter also discussed peer review processes, advising surgeons to control the narrative in medical charts, respond non-defensively to inquiries, and seek legal counsel if necessary. They emphasized the importance of measuring outcomes and knowing one's numbers to build confidence. The session concluded with advice on debriefing with teams and communicating with patients' families after complications, emphasizing the need to address emotional concerns before providing technical details. Chapters Introduction to Complications in Surgery ‎ 00:00:00 The presenter welcomed attendees to day three of launch week, focusing on complications in surgery. They acknowledged that while complications may seem like a heavy topic, it's important because all surgeons will experience them. The presenter introduced themselves as a surgeon, author, podcast host, and certified coach, emphasizing that complications are "near and dear to their heart." They outlined the main topics to be covered: what a complication is, perfectionist thinking, asking for help, the prolonged stress cycle, self-compassion, managing negative emotions, shame resilience, confidence and self-confidence, and peer review assessment. Understanding Complications and Perfectionist Thinking ‎ 00:01:46 The presenter began by addressing two common statements about surgical complications: "The only surgeon who doesn't have complications is the one who doesn't operate" and "Every surgeon carries within himself a small cemetery where from time to time he goes to pray." They defined a complication as a failure to achieve a stated outcome - specifically, a perfect procedure. The presenter discussed perfectionist thinking as a double-edged sword, explaining that while striving for perfection seems admirable, it can lead to fear, overwork, and burnout. They recommended shifting perspective from focusing on the gap between achievement and perfection (e.g., achieving 95% vs. 100%) to celebrating the best effort given with available knowledge and resources. The Prolonged Stress Cycle ‎ 00:07:17 The presenter explained how surgeons often experience prolonged stress cycles without recovery, especially when dealing with complications, hostile work environments, or difficult patients. They emphasized that surgical jobs are inherently difficult, stating "Our jobs are hard. Not everyone can do it." When stress continues without relief, it can lead to rumination, hypervigilance, isolation, impaired cognitive function, decreased empathy, irritability, anxiety, depression, and potentially self-harm. The presenter recommended strategies to interrupt this cycle, including deep breathing (especially exhaling), music, exercise, mindset work through neuroplasticity, and community support. Managing Complications During Surgery ‎ 00:11:25 For handling complications during surgery, the presenter advised: checking one's pulse first, taking deep breaths to interrupt the stress cycle, stepping back to think about what you know, asking for help, and considering the next best step. They used the analogy of viewing a maze from above versus being inside it to illustrate the importance of perspective. The presenter emphasized that how a surgeon responds during a complication influences everyone in the operating room, as they are all experiencing stress and looking to the surgeon for leadership. Asking for Help and Managing Expectations ‎ 00:13:51 The presenter discussed the importance of clear communication when asking for help, emphasizing understanding both your expectations and your partner's expectations. They shared examples of misunderstandings, such as a junior surgeon expecting a senior partner to scrub in during a complication while the senior partner was hesitant to appear to be taking over. The presenter advised explicitly stating what you need: "If you're the person in the operation and you want them to scrub in, just say, 'Hey, I really need you, can you scrub in?'" They also addressed "want mismatches" where partners have different expectations and recommended finding alternative sources of help if necessary. After the Complication: Managing Emotions ‎ 00:18:51 The presenter emphasized the importance of naming emotions after a complication occurs, describing it as learning a new language of emotional intelligence. They discussed "emotional alchemy" - the ability to transform one emotion into another, particularly distinguishing between guilt ("I feel bad that this event happened") and shame ("I feel bad because there's something wrong with me"). The presenter introduced Brené Brown's shame resilience framework: reaching out to trusted sources, talking kindly to oneself (self-compassion), and owning the story to control the ending. They explained self-compassion as "feeling a negative emotion and wrapping it up in love and respect for yourself." Communicating with Patients After Complications ‎ 00:24:51 The presenter shared insights about what patients want after complications: to know what happened while they were asleep, to know the surgeon did their best, to feel they won't be abandoned, and to know the surgeon learned from the experience. They emphasized the importance of giving complications purpose and using them as learning opportunities. The presenter advised being present with patients, acknowledging the reality of what happened, and providing certainty and stability during a confusing time. Peer Review and Professional Consequences ‎ 00:27:12 The presenter discussed peer review processes, acknowledging that surgeons have reason to be concerned but emphasizing that the goal should be quality improvement and patient safety. They advised controlling the narrative in medical charts by clearly documenting decision-making processes. The presenter outlined possible peer review outcomes: no action (sometimes even congratulations for handling difficult situations well), education/questioning, remediation requirements, or more serious consequences like privilege restrictions or National Data Bank reporting. They advised not signing anything without careful consideration and possibly consulting a lawyer if serious concerns arise. Building Confidence Despite Complications ‎ 00:33:48 The presenter distinguished between confidence ("I know I can do it because I've already done it") and self-confidence (the ability to take chances, stretch oneself, and manage failure). They recommended breaking down complex procedures into components, recognizing that surgeons typically know 95% of what they need to do, with only 5% requiring special focus. The presenter emphasized the importance of measuring outcomes and knowing one's numbers (complication rates, case volumes, etc.) to build confidence and counter drama with facts: "Information is the best solution when you have drama. Math always settles down drama." Debriefing with Teams and Families ‎ 00:41:54 In response to audience questions, the presenter discussed the importance of debriefing with both teams and patients' families after complications. For families, they advised leading with emotional reassurance before providing technical details: "First, I know things took a little longer, but everything is okay." For team debriefs, they recommended acknowledging everyone's efforts, discussing what went well and what could have gone better, and identifying next steps. The presenter also endorsed proactively reporting complications to administrators rather than waiting to be discovered: "Don't give into that kind of suffering... You're going to decrease the amount of suffering that you're going to have by doing that." Action Items The presenter recommended shifting perspective from focusing on the gap between achievement and perfection to celebrating the best effort given with available knowledge and resources. ‎

n this episode, Dr. Amy Vertrees sits down with her longtime office manager, Carrie Glass, to unpack one of the most overlooked yet critical dynamics in a physician’s career: the relationship between doctor and office manager. With decades of experience running medical offices, Carrie shares insider knowledge that every new attending needs to hear—from credentialing pitfalls and the revenue cycle to handling disruptive patients, managing staff, and mastering delegation. Together, Dr. Vertrees and Carrie explore how communication, boundaries, and trust between physicians and office managers can quite literally “make or break your life in the clinic.” Carrie also introduces her new venture, Medical Office Mastery, designed to equip both physicians and office managers with the tools they need for smoother, more effective practice management. 💡 Whether you’re a brand-new attending or a seasoned physician looking to strengthen your team, this episode delivers actionable advice to help you build a foundation of success in your practice. Highlights include: Why your relationship with your office manager is one of the most important of your career The hidden paperwork and credentialing hurdles new attendings face (and how to get ahead of them) How communication style sets the tone before you even arrive in practice The physician’s role in the revenue cycle and why timely documentation matters The behind-the-scenes heroics of prior authorizations and last-minute surgeries Strategies for managing disruptive patients, toxic staff, and no-shows The right way to delegate—and why skipping training leads to burnout and frustration The value of regular meetings and clear professional boundaries Why appreciation and recognition matter more than donuts 👉 Resources & Links Learn more about Carrie’s new program: Medical Office Mastery here 

How do surgery residents find their first job—and keep it? In this episode, Dr. Amy Vertrees sits down with Dr. Sharon Stein, a colorectal surgeon turned professional development coach, to talk about her new program designed to help residents land jobs that truly fit their goals and values. Dr. Stein shares eye-opening statistics: 15% of surgeons leave their first job within 2 years. 50% leave within 5 years. The problem? Training programs teach standardized skills but don’t help surgeons identify their unique strengths—or what they really want in a job. Together, Dr. Vertrees and Dr. Stein discuss: ✅ Why comparison (not competition) derails job searches ✅ The mid-career slump and how to prevent it ✅ A 4-step framework for assessing, interviewing, evaluating, and negotiating job offers ✅ How institutions (and surgeons) can avoid the high cost of misaligned job placements Dr. Stein’s new six-month program includes on-demand modules, group coaching, and one-on-one sessions—limited to 30 graduates across all surgical specialties. 🔑 Key Takeaways Clarity comes first: Identify negotiables and non-negotiables before interviewing. It’s not just salary: Evaluate culture, mentorship, and long-term growth. Negotiation = relationship building, not confrontation. Coaching isn’t just for the lost— it’s for creating sustainable, fulfilling careers. 📌 Resources & Links Learn more about Dr. Sharon Stein: theintentionalsurgeon.com  Access her free Launch Pad Checklist here:https://sharon-stein.mykajabi.com/opt-in ✨ If you’re a surgical resident—or know one—this episode is a must-listen for setting up a thriving career from the start.

What happens when a “good job” no longer feels good enough? In this episode of the BOSS Business of Surgery Series Podcast, Dr. Amy Vertrees sits down with Dr. Yemi Lamikanra, orthopedic hand surgeon and founder of Cura Hand Surgery and Orthopedics in Atlanta, to discuss her bold decision to leave a large multi-specialty group and start her own solo practice. Dr. Lamikanra opens up about the pivotal moments that led her to seek change, including the pressures of balancing motherhood with her surgical career. She shares the strategies, resources, and mindset shifts that helped her build a practice that fits her life—and why trusting yourself is often the hardest, but most important, step. You’ll learn: How motherhood reshaped her priorities and pushed her toward autonomy Why “10X is easier than 2X” when making major life changes Lessons from setbacks that became invaluable in leadership, coding, and patient acquisition How to evaluate consultants and ensure a return on investment The power of community, self-education, and intentional decision-making in private practice Dr. Lamikanra’s journey is an inspiring reminder that your purpose is always bigger than your fear—and that redefining success is not only possible, but necessary. Resources & Links: Connect with Dr. Yemi Lamikandra: Website: atlantahandsurgeon.com Instagram: @atlhandsurgeon LinkedIn: Opeyemi Lamikanra, MD 🎧 Listen now and be inspired to design a career—and life—that works for you.

Summary Dr. Amy Vertrees, a surgeon, author, podcast host, and certified coach, delivered the first session of a launch week series aimed at new attending physicians. The presentation focused on common mistakes new attendings make and strategies to avoid them. Dr.Vertrees emphasized that the information shared was based on her own experiences and lessons learned throughout her career. Dr.Vertrees began by outlining the week-long series of presentations, which would cover topics including office manager insights, money management for physicians, handling complications, legal risks, time management, and efficient note-taking. She emphasized that these sessions were designed to be interactive, encouraging participants to ask questions through chat or Q&A features. A central theme of Dr.Vertrees' presentation was the importance of mastery and recognition for job satisfaction. She explained that mastery means being good at one's job, while recognition involves being acknowledged for one's skills and contributions. Dr.Vertrees noted that this formula applies not only to physicians but to everyone in the workplace, highlighting the importance of recognizing others' contributions and allowing them to develop mastery in their roles. Dr.Vertrees discussed the significance of understanding organizational culture, including the mission, beliefs, and values of one's workplace. She advised new attendings to consider whether their personal values align with their organization's culture, as misalignment can lead to dissatisfaction. She also emphasized that new physicians bring valuable perspectives and should feel confident in suggesting changes, though she recommended approaching such suggestions carefully by first asking questions to understand existing practices. The presentation covered strategies for dealing with difficult colleagues, emphasizing that communication breakdowns can make any colleague difficult. Dr.Vertrees offered practical advice for improving interactions, including focusing on what people actually say rather than interpretations, examining what meaning one assigns to others' words, and understanding one's own stress responses (fight, flight, freeze, or fawn). She suggested that recognizing these patterns in oneself can help in understanding others' behaviors as well. Dr.Vertrees addressed the topic of being reported or receiving negative feedback, advising attendees to view such situations as opportunities for growth rather than threats. She emphasized the importance of participating in leadership positions and committees to have influence in one's organization, noting that "you're either at the table or you're on the menu." The presentation also covered personal development topics such as overcoming imposter syndrome, which Dr.Vertrees defined as feeling inadequate despite demonstrated success. She offered strategies for challenging negative thoughts by turning statements into questions and comparing oneself to past versions rather than to others. Dr.Vertrees distinguished between confidence (which comes from repeated experience) and self-confidence (the courage to act despite fear). Dr.Vertrees discussed the importance of marketing oneself effectively, emphasizing that marketing involves knowing one's values and being authentic. She encouraged attendees to embrace their unique qualities rather than conforming to stereotypical surgeon personas. She also addressed the topic of getting paid appropriately, emphasizing the importance of timely documentation, proper coding, and understanding the revenue cycle. The presentation concluded with advice on tracking various aspects of one's practice, including finances, cases, clinic metrics, and complications. Dr.Vertrees stressed the importance of adapting to life changes and having contingency plans, including knowing one's contract details and having an exit strategy. She offered strategies for dealing with negative emotions, particularly shame, and emphasized the importance of seeking help when needed. Throughout the presentation, Dr.Vertrees maintained that physicians should give themselves permission to quit if necessary, while also finding purpose in their work. She concluded by emphasizing treatments that address root problems, including therapy, coaching, journaling, community support, and sometimes medications. Chapter Introduction to Launch Week for New Attendings ‎ 00:00:02 Dr. AmyVertrees welcomed participants to the first day of launch week, designed specifically for new attending physicians. She explained that the purpose of these sessions was to share information she wished she had known when starting as a new attending. Dr.Vertrees encouraged interaction through chat or Q&A features and introduced herself as a surgeon, author, podcast host, and certified coach. She outlined the week's topics, including office manager insights, money management, handling complications, legal risks, time management, and efficient note-taking. Mastery and Recognition: The Key to Job Satisfaction ‎ 00:03:20 Dr.Vertrees identified mastery and recognition as the fundamental elements of job satisfaction. She defined mastery as being good at one's job and recognition as being acknowledged for one's skills and contributions. She emphasized that this formula applies to everyone in the workplace and highlighted the importance of recognizing others' contributions. Dr.Vertrees cautioned against the mistake of doing everything oneself, as this robs others of the opportunity to develop mastery and receive recognition. Understanding Organizational Culture ‎ 00:05:28 Dr.Vertrees discussed the importance of understanding the culture of one's organization, including its mission, beliefs, and values. She advised attendees to consider whether their personal values align with their organization's culture, noting that misalignment becomes evident over time. Dr.Vertrees emphasized that new physicians bring valuable perspectives and should feel confident in suggesting changes, though she recommended approaching such suggestions carefully by first asking questions to understand existing practices. Navigating Difficult Colleagues and Communication ‎ 00:07:46 Dr.Vertrees addressed the challenge of difficult colleagues, noting that communication breakdowns can make any colleague difficult. She offered practical advice for improving interactions, including focusing on what people actually say rather than interpretations, examining what meaning one assigns to others' words, and understanding one's own stress responses (fight, flight, freeze, or fawn). She suggested that recognizing these patterns in oneself can help in understanding others' behaviors as well. Handling Reports and Feedback ‎ 00:11:52 Dr.Vertrees discussed how to handle situations where one is reported or receives negative feedback. She advised viewing such situations as opportunities for feedback rather than threats, noting that a report simply generates paperwork that someone needs to address. She emphasized the importance of maintaining a good headspace to respond appropriately, whether the feedback indicates an area for personal improvement or a situation to be cautious about. Participating in Organizational Leadership ‎ 00:13:31 Dr.Vertrees emphasized the importance of participating in leadership positions and committees to have influence in one's organization, stating "you're either at the table or you're on the menu." She encouraged attendees to get involved at hospital, state, or national levels, while being selective about which positions to take on. Dr.Vertrees advised being clear about one's motivations for taking on leadership roles and understanding that such roles are often what one makes of them. Creating Personal Safety and Understanding Values ‎ 00:15:18 Dr.Vertrees discussed the importance of understanding one's personal culture and values, especially when working in a difficult organizational culture. She emphasized that clarity about one's values helps in making decisions and recommended values exercises to gain self-awareness. Dr.Vertrees addressed the concept of scarcity, noting that feelings of not having enough can trigger unhelpful "hustle" behaviors and that new physicians may trigger scarcity feelings in established colleagues. Establishing Boundaries ‎ 00:18:32 Dr.Vertrees outlined five steps for establishing effective boundaries: defining the boundary, communicating it to relevant parties, outlining consequences for boundary violations, enforcing those consequences, and allowing oneself to make exceptions when appropriate. She used the example of after-hours patient calls to illustrate these steps, emphasizing that a boundary isn't truly established unless all five steps are followed. Addressing Imposter Syndrome ‎ 00:21:09 Dr.Vertrees defined imposter syndrome as feeling inadequate despite demonstrated success, a phenomenon first identified in high-achieving women in academia in 1978. She explained that people with imposter syndrome have negative thoughts despite outward success, making it difficult for others to understand or help. Dr.Vertrees suggested turning negative statements into questions to challenge these thoughts, such as changing "I'm not doing this right" to "Am I okay?" Challenging Common Negative Thoughts ‎ 00:24:50 Dr.Vertrees identified common negative thoughts that high-achieving people experience, including fears of being perceived as lazy, doubts about one's abilities, and comparisons to others. She emphasized that these thoughts can be challenged and reframed, noting that the job itself is genuinely difficult and that comparing oneself to others can be useful if done constructively rather than destructively. Understanding Confidence and Self-Confidence ‎ 00:32:18 Dr.Vertrees distinguished between confidence, which comes from repeated experience, and self-confidence, which is the courage to act despite fear. She explained that confidence develops through muscle memory and repet

Episode Summary: In this deeply moving and practical episode, palliative care nurse Tammy Stokes shares how a personal health crisis at age 36—nearly 100% blockage in three arteries—transformed her career and mission in healthcare. Now an advocate and leader in palliative care in Tennessee, she brings firsthand experience and clinical insight to the often-avoided conversations about serious illness, family dynamics, and end-of-life care. Tammy discusses: The difference between palliative and hospice care The emotional and spiritual impact of critical illness on patients and families Why advanced care planning is essential—at any age How her personal experiences with her father and brother shaped her philosophy of care Tools from her book, including scripts to start hard conversations The power of patient autonomy and how to honor it in clinical practice Whether you’re a surgeon, nurse, or family caregiver, this episode equips you to lead hard conversations with courage, compassion, and clarity. 🧠 Key Topics: [00:00] Introduction to Tammy Stokes and her book [00:03] Her personal health crisis and its impact [00:06] Transformation into a more compassionate nurse [00:12] Transition into palliative care and first patient experience [00:17] Scripts and strategies for difficult conversations [00:22] Creating communication plans with patients and families [00:31] Handling family disagreements and honoring patient wishes [00:35] The case for early and ongoing advance care planning [00:39] Real-life stories of honoring her father’s and brother’s end-of-life preferences 📘 Resources Mentioned: Break the Silence: Health Conversations You Can’t Ignore by Tammy Stokes Tennessee Palliative Care Advisory Council Hospice and Palliative Care Nurses Association 📌 Takeaways: Start the conversation before the crisis. Honor what patients want, not what we fear. Be vulnerable—it opens the door to trust and truth. Scripts and structured communication can reduce fear and overwhelm. 🔗 Connect with Tammy: Facebook: Tammy Stokes – Break the Silence: Health conversations you can't ignore, buy it here Speaking engagements: Reach out via her Facebook page, Tammy Stokes Book Launch Party 8/1 🎧 Listen to More: Subscribe to the BOSS Business of Surgery Series for more real conversations about what really matters in medicine. I would appreciate if you rate and review the show as well!

Summary Amy introduces Dr. Adam Rosen, an orthopedic surgeon and author of "OR Confidential: Confessions of a Gen X Surgeon," highlighting the book's exploration of the challenges and mental health struggles faced by physicians, especially during the COVID-19 pandemic. She emphasizes the book's relevance to both medical professionals and patients seeking to understand the physician's journey, its consequences, and recovery . 00:00:02 Dr. Rosen shares his lifelong aspiration to become an orthopedic surgeon, detailing his training and career until his mental health crisis in 2023, which led to a year-long absence from work. He reflects on the initial desire to help people that drives many into medicine, contrasting it with the systemic pressures that erode empathy and compassion over time . 00:01:38 The discussion shifts to the impact of COVID-19 on surgical teams and patient care. Dr. Rosen describes the efficiency and synergy of his pre-COVID team, where experienced members anticipated his needs, leading to streamlined procedures. He contrasts this with the challenges of working with traveling staff during the pandemic, who, despite being highly paid, lacked familiarity with the hospital's systems and procedures, causing frustration among permanent staff . 00:04:47 Dr. Rosen elaborates on the emotional toll of striving for perfection in an environment of constant staffing and supply chain issues. He recounts his hypervigilant state, driven by the need to ensure optimal patient care amidst systemic challenges, which ultimately led to his mental health breakdown. He also mentions a quote in his book from the Hip and Knee Society about the high percentage of doctors still facing supply chain and staffing issues years after COVID . 00:08:57 Dr. Rosen describes the red flags he missed leading up to his breakdown, including chronic sleep deprivation, increased alcohol consumption, cessation of exercise and meditation, and social withdrawal. He acknowledges the feeling of being trapped by financial obligations and professional responsibilities, which prevented him from addressing his deteriorating mental health . 00:11:17 Dr. Rosen recounts the events leading to his breakdown, triggered by a combination of hospital issues, electronic medical record stress, insurance demands, a patient complication, and a lawsuit. He describes waking up one Friday unable to get out of bed, experiencing a sense of detachment at work, and ultimately being unable to move, leading to a three-week period of isolation . 00:14:34 Dr. Rosen reflects on a prior panic attack, which he initially dismissed, and contrasts it with the overwhelming fear and inability to function that characterized his breakdown. He credits his wife and therapist for intervening and initiating his treatment, highlighting the importance of support systems and access to mental healthcare . 00:18:43 Dr. Rosen discusses his experience with psychiatric treatment, including medication and an intensive outpatient program involving cognitive behavioral therapy (CBT) and group therapy. He describes the challenges of accepting the healthcare system's limitations while striving for optimal patient care, and the difficulty of admitting the need for help due to stigma . 00:26:26 Dr. Rosen emphasizes the importance of continuous self-assessment and seeking help, recounting how sharing his experiences has become easier over time. He notes the surprising number of older colleagues who have privately struggled with similar issues, underscoring the prevalence of mental health challenges in the medical profession . 00:35:06 Dr. Rosen details the tools and strategies he has adopted to manage his mental health, including mindfulness meditation, regular exercise, nutritious eating, social interaction, and creative outlets like writing and YouTube. He shares a personal anecdote about reframing frustrating situations by rewarding himself with a treat, illustrating his approach to managing stress . 00:36:50 Dr. Rosen discusses the principles of cognitive behavioral therapy (CBT), including identifying and challenging negative core beliefs and cognitive distortions. He recounts his experience in group therapy, where he had to confront his belief that he was a failure and reframe his narrative . 00:41:16 Dr. Rosen describes his current activities, including his YouTube channel, which provides information and support to patients undergoing knee replacement surgery. He also mentions his plans to resume work on a fictional medical crime thriller . 00:50:24 Amy commends Dr. Rosen for his openness and advocacy, highlighting the value of his resources for patients and healthcare professionals. She also acknowledges the unique challenges faced by female surgeons and expresses appreciation for initiatives supporting them . 00:54:51 Chapter Introduction to Dr. Adam Rosen and His Book 00:00:02 Amy introduces Dr. Adam Rosen, highlighting his book "OR Confidential: Confessions of a Gen X Surgeon," which explores the mental health challenges faced by physicians, especially during the COVID-19 pandemic. She emphasizes the book's relevance to both medical professionals and patients seeking to understand the physician's journey, its consequences, and recovery. Dr. Rosen's Journey to Becoming a Surgeon 00:01:38 Dr. Rosen shares his lifelong aspiration to become an orthopedic surgeon, detailing his training and career until his mental health crisis in 2023, which led to a year-long absence from work. He reflects on the initial desire to help people that drives many into medicine, contrasting it with the systemic pressures that erode empathy and compassion over time. The Impact of COVID-19 on Surgical Teams 00:04:47 The discussion shifts to the impact of COVID-19 on surgical teams and patient care. Dr. Rosen describes the efficiency and synergy of his pre-COVID team, where experienced members anticipated his needs, leading to streamlined procedures. He contrasts this with the challenges of working with traveling staff during the pandemic, who, despite being highly paid, lacked familiarity with the hospital's systems and procedures, causing frustration among permanent staff. He notes that travelers were often paid two to three times what the home market paid. The Emotional Toll of Striving for Perfection 00:08:57 Dr. Rosen elaborates on the emotional toll of striving for perfection in an environment of constant staffing and supply chain issues. He recounts his hypervigilant state, driven by the need to ensure optimal patient care amidst systemic challenges, which ultimately led to his mental health breakdown. He also mentions a quote in his book from the Hip and Knee Society about the high percentage of doctors still facing supply chain and staffing issues years after COVID. Red Flags and the Feeling of Being Trapped 00:11:17 Dr. Rosen describes the red flags he missed leading up to his breakdown, including chronic sleep deprivation, increased alcohol consumption, cessation of exercise and meditation, and social withdrawal. He acknowledges the feeling of being trapped by financial obligations and professional responsibilities, which prevented him from addressing his deteriorating mental health. The Breaking Point 00:14:34 Dr. Rosen recounts the events leading to his breakdown, triggered by a combination of hospital issues, electronic medical record stress, insurance demands, a patient complication, and a lawsuit. He describes waking up one Friday unable to get out of bed, experiencing a sense of detachment at work, and ultimately being unable to move, leading to a three-week period of isolation. Panic Attack and the Importance of Support Systems 00:18:43 Dr. Rosen reflects on a prior panic attack, which he initially dismissed, and contrasts it with the overwhelming fear and inability to function that characterized his breakdown. He credits his wife and therapist for intervening and initiating his treatment, highlighting the importance of support systems and access to mental healthcare. Psychiatric Treatment and the Stigma of Mental Health 00:26:26 Dr. Rosen discusses his experience with psychiatric treatment, including medication and an intensive outpatient program involving cognitive behavioral therapy (CBT) and group therapy. He describes the challenges of accepting the healthcare system's limitations while striving for optimal patient care, and the difficulty of admitting the need for help due to stigma. The Importance of Continuous Self-Assessment 00:35:06 Dr. Rosen emphasizes the importance of continuous self-assessment and seeking help, recounting how sharing his experiences has become easier over time. He notes the surprising number of older colleagues who have privately struggled with similar issues, underscoring the prevalence of mental health challenges in the medical profession. Tools and Strategies for Managing Mental Health 00:36:50 Dr. Rosen details the tools and strategies he has adopted to manage his mental health, including mindfulness meditation, regular exercise, nutritious eating, social interaction, and creative outlets like writing and YouTube. He shares a personal anecdote about reframing frustrating situations by rewarding himself with a treat, illustrating his approach to managing stress. Cognitive Behavioral Therapy (CBT) and Challenging Negative Beliefs 00:41:16 Dr. Rosen discusses the principles of cognitive behavioral therapy (CBT), including identifying and challenging negative core beliefs and cognitive distortions. He recounts his experience in group therapy, where he had to confront his belief that he was a failure and reframe his narrative. Current Activities and Future Plans 00:50:24 Dr. Rosen describes his current activities, including his YouTube channel, which provides information and support to patients undergoing knee replacement surgery. He also mentions his plans to resume work on a fictional medical crime thriller. Commendations and Acknowledgements 00:54:51 Amy comme

🔍 Episode Overview: In this powerful episode, general surgeon Dr. Courtney Kemp shares her journey from a small town in Montana to establishing a successful private practice in Minnesota. She opens up about the pivotal moments that led her to become a national advocate for medical liability reform, and how early career complications transformed her into a leader in physician protection and legislative change. 🧠 Key Themes & Takeaways: Early Career & Mentorship: Grew up in a rural town with limited exposure to medicine. Influenced by college professors and supportive residency leadership at Hennepin. Chose private practice for flexibility and family reasons. Business of Private Practice: Highlights the importance of understanding practice finances, proper documentation, and timely invoicing. Advocates for collaboration between employed physicians and private practice. Medical Liability Awareness: Two early complications (port placement and retained sponge) ignited her passion for liability reform. Became active in her liability insurance board to understand systemic issues. Litigation’s Toll on Physicians: Emotional, financial, and reputational damage of being sued. Shocking statistics: 500% rise in litigation with increased transparency. Describes physician vulnerability and altruism as a double-edged sword. Legal & Legislative Advocacy: Helped create Minnesota Physicians for Reform. Modeled reform efforts after Utah’s bill (caps on non-economic damages, asset protections). Explained different types of damages and need for fair caps to protect access to care. Current Climate & Physician Risks: Growing threats include cyberbullying, violence, and suicide—often connected to litigation stress. Discusses social inflation, reptile theory, and litigation financing as rising threats. Remediation & Patient Trust: Advocates for early, honest communication after harm events. Encourages open dialogue, assuming good intent, and sharing knowledge with patients. Call to Action for Physicians: Get involved with state health committees, medical societies, and tort reform efforts. Talk to legislators and medical liability carriers (like SVMIC). Visit www.healthcare4reform.org to learn more and take action.